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Breast-feeding, maternal CD4 count and child death.

Cessation of breast-feeding plays a small mediating role in the association between maternal CD4 count and child mortality, according to an analysis of data from the Zambia Exclusive Breastfeeding Study conducted in Lusaka. (1) Of the pregnant HIV-positive women recruited for the study between May 2001 and September 2004 and counseled to breast-feed their baby exclusively for at least six months, 357 had live-born, singleton infants who did not test positive for HIV during the 18-month follow-up period. Forty-five of those infants died during the study period, 17 within the first six months. Fifty-five percent of mothers had a CD4 count during pregnancy of more than 500, 28% had a CD4 count between 200 and 500, and 18% had a CD4 count of less than 200. Compared with children whose mother had a CD4 count of more than 500, those whose mother had a CD4 count of less than 200 had an increased risk of death (incidence rate ratio, 3.2). Similarly, a low maternal CD4 count was positively associated with cessation of breastfeeding (1.8). In regression analyses that estimated the association between maternal CD4 count and child mortality, with and without adjustment for breast-feeding, only a small amount of the association was mediated through cessation of breast-feeding. The authors suggest that in addition to breastfeeding, factors such as infectious disease, low birth weight and poor growth also explain the association between maternal CD4 count and child mortality.

(1.) Fox MP et al Role of breastfeeding cessation in mediating the relationship between maternal HIV disease stage and increased child mortality among HIV-exposed uninfected children, International Journal of Epidemiology, 2009, 38(2):569-576.

Update is compiled and written by Jared Rosenberg, senior editor of International Perspectives on Sexual and Reproductive Health.

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Title Annotation:UPDATE
Author:Rosenberg, Jared
Publication:International Perspectives on Sexual and Reproductive Health
Article Type:Author abstract
Geographic Code:6ZAMB
Date:Sep 1, 2009
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